Protocols - Hemorio

ASPIRIN AND NSAID
PARACETAMOL
OPIOID
ERGOTAMINE AND
PROPANOLOL
ANTICONVULSIVE
ANTIDEPRESSANTS
Associated to 80% of abortion, it is not recommended to use some days after conception
and 1 week later. In addition, at the first quarter, it may increase the risk of cause
malformation, such as gastroschisis.
It seems to be the safer and it is not associated to the increased abortion index. However,
measures must be taken regarding dose and treatment time.
In the uterus, continued opioid exposition seems to increase pain sensibility and increase
tolerance, as well as some psychological and behavior changes. There are evidences of
down-regulation in opioids recipients during second and third quarter, but it seems that
these changes return to normal after a stopping administrating opioid, which reflects a quick
change and development in the opioid in the immature brain, with a brief period of
hypersensitivity
Methadone: increases clearance, but it is the most used opioid in pregnant women to treat
disintoxication, being the easiest to handling, despite of occurring Neonatal Abstinence
Syndrome.
Buprenorphine: has been used in some cases, however with fewer studies. In order to
minimize the effects and risks, epidural via must be considered.
Dextrometorphane and Ketamine: Dextrometorphane is Codeine isomer and in Brazil is
present as an antitussive, and once there is an antagonist effect of NMDA receptors, like
ketamine, may be used during pregnancy.
Used for migraine and they are related in some papers about congenital defects, which
require more researches.
Phenotyoine, Valproate, carbamazepine, and phenobarbital are associated to congenital
problems and malformations, so they should not be used.
There are only studies about inhibitors of recaptation of serotonin, which are used on post
partum depression. Diazepam, as sedative, is cited as safe during pregnancy, but during
breastfeeding may cause lethargy and weight loss on the newborn.
8 – LEG ULCERS
Patients may be conducted to Bandage Room to evaluation and conduction, whose protocol is:
PRESCRIPTION: Maintain hydrated skin, using socks and high top shoes.
CLEANING – lesion must be cleaned with saline solution warmed between 36 to 37ºC. At the perilesional
skin, use digerm clorexedine 4%. Depending on the features of interface, there will have variation of
techniques:
- Clean wounds and granulate: through jet;
- Residual wounds: with dry sponge (without PVPI) – perform friction or carefully pressure;
- Deep wounds, narrow or with dead space: irrigation through ureteral or retal catheter attached to a 20
ml syringe
- Extremely dirty wounds, attaching in the bed or infected: dry sponge (without PVPI) – to perform
friction with more mechanical strength.
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